The CEO of Aetna embraces quackery

Everyone hates health insurance companies. At least, so it seems. Personally, I’ve had my issues with such companies myself, particularly when having to deal with them when they refuse to cover certain medical tests for my patients. Fortunately for me, surgical oncology is a specialty that doesn’t have a lot of tests or treatments that are frequently not covered, particularly for breast cancer surgery, which means that I don’t have to deal with insurance companies that much. It’s a wonderful thing for a doctor.

Still, for all the complaining about insurance companies, if there’s one good thing about them it’s that they usually don’t cover treatments and tests that don’t have a reasonable evidence base for them, and, by and large, they don’t cover much in the way of “complementary and alternative medicine” (CAM) because, quite rightly, they consider it a waste of money from their customers’ premiums to pay for magic. Unfortunately, to some extent this is changing a bit. Some insurance plans will pay for chiropractic care, for instance. That bothers me, although I suppose it can be argued that, as long as a chiropractor sticks to spinal manipulation only for musculoskeletal problems (i.e., functions more as a physical therapist than anything else, rather than a physical therapist with delusions of grandeur who thinks that spinal manipulation can treat, for example, asthma or autism), they probably can help. What bothers me more than coverage for chiropractic is my increasing observation that more and more health insurance companies are covering quackery like acupuncture and other services commonly provided by naturopaths.
So, for all the opprobrium heaped upon health insurance companies, by and large they don’t pay for much quackery, despite intense efforts by naturopaths and other CAM practitioners to persuade them to do so, and that’s a good thing, a public service if you will. That’s why I was disturbed to see a story on Forbes.com the other day entitled Aetna CEO Embraces Alternative Healthcare:

Aetna CEO Mark Bertolini surprised many Techonomists at our conference in Tucson last month with his frank talk about alternative therapies and the need for the current health system to be “creatively destroyed.” Who would have thought the top man at one of the nation’s largest health insurance companies would be an advocate for craniosacral therapy and meditative chanting?

Bertolini’s onstage interview with David Kirkpatrick focused mostly on his innovative approaches to apps and technology at the company. But in a later on-camera conversation, Bertolini described how his progressive personal health practices jibe with his company’s mission.

I think the key statement in this interview is very revealing. Bertolini says:

We know this stuff works. We believe in this, it’s just building the evidence base.

That’s right. He “knows” this stuff works already. He’s just looking for evidence to convince everyone else that it “works.” Also, like any good businessman, he further says, after mentioning quackery like craniosacral therapy, and comfort modalities that aren’t really “therapies” per se (like massage):

It’s a lot of money, and I think people want it, and they find it valuable. That’s how I manage it. I go to a naturopath to get my blood test and I have food sensitivities. I’ve lost 48 lbs, just by having my blood tested. Allopathic doctors will say that’s all crazy, you’re just watching your diet as a result of getting some blood work back. No, I’m not eating eggs, I’m not eating milk. I’m not taking any dairy, and I’ve lost 48 lbs.

Actually, the “allopathic” doctors are probably correct. That’s all that’s likely going on. You can eliminate a lot of calories by eliminating dairy from your diet. If you happen to exercise and, as a lot of naturopaths like to promote, become a vegetarian, you can lose a lot of weight. We have no idea what other dietary changes Bertolini might have made made. He sure is proud of himself, though, and not afraid to let you know it. Particularly obnoxious is his bragging about taunting his “allopathic doctor, saying, “You’re 30 pounds overweight. How’s your nutritional therapy working for you?”

Apparently, Bertolini was converted to CAM by two events in his life. First, of all, his son developed what is normally a fatal cancer. I haven’t been able to find out what cancer Bertolini’s sone developed, but Bertolini frequently makes the claim that his son is the first person ever to have survived this particular “rare, incurable cancer.” Apparently it was Gamma Delta T-cell lymphoma, a form of lymphoma I don’t remember ever having heard of before. It’s described as an “extremely rare and aggressive disease that starts in the liver or spleen.” It is indeed a bad actor. However, there is evidence that not all Gamma Delta T-cell lymphoma is so rapidly deadly, with reports of some cases that show a much less aggressive course. We have no way of knowing whether Bertolini’s son had one such less aggressive form based on the description of his clinical course found in various news reports, which involved a bone marrow transplant, a case of graft versus host disease, and complications including strokes and renal failure that ultimately necessitated a kidney transplant. Be that as it may, I can understand why this experience might have soured Bertolini on “conventional medicine.”

Thus were the seeds sown that later grew into Bertolini’s embrace of the quackery that is naturopathy, but more was needed. This additional trigger that was needed came in the form of a life-altering serious injury. Bertolini, although an expert skiier, had a skiing accident in 2004, in which he wiped out badly, suffered a severe concussion, and broke five vertebrae in his neck, ripping the nerve roots on the left out of the spinal cord. The results were severe pain:

For the first year, Bertolini used a plethora of narcotics for the pain such as Oxycontin, Vicodin, and Fentanyl and still barely slept at night. He says he didn’t get hooked on the drugs, insisting he’s more of an “adrenaline-endorphin junkie.” At his wit’s end, he went looking for better treatments.

The solutions include weekly cranial sacral massage, which involves the head all the way down to the tailbone, aimed at getting a flow of spinal fluid that calms the nervous system, Bertolini said. The massage got him off narcotics in four months, and he says he now takes nothing but Tylenol for the pain.

He also got acupuncture in Boston for a year and now keeps needles at home and when traveling to self-administer the treatment.

Ashtanga yoga, he says, also helps him deal with pain and restore a sense of well-being he used to get from daily 5 a.m. 4-mile runs, which he can’t do anymore.

Does it need to be repeated that cranial sacral massage is one of the rankest forms of quackery? There are also parts of this story that are very common in testimonials for alternative medicine. For example, he attributes his getting off of narcotics to the craniosacral massage, but more likely it’s just the tincture of time, and he would have gotten off the narcotics in four months regardless. We have no way of knowing, but I do know that correlation does not equal causation. Of course, once someone has developed the tendency to believe in woo, if he’s doing conventional therapy and woo when his condition gets better, he’ll attribute the recovery to the woo, not to the conventional medicine. It’s quite possible that the yoga might have helped, basically because it’s a set of stretching exercises, but I’ve also heard a neurosurgeon tell me that yoga is not good for injured spines. Be that as it may, now Bertolini is a full-fledged believer in naturopathy to the point where was the keynote speaker at the New York Association of Naturopathic Physicians’ annual conference:

The first part of the video is a dry discussion of Obamacare, but at around 3:30 the mistress of woo who runs what I like to refer to as a “wretched hive of scum and quackery” (i.e., The Huffington Post), Arianna Huffington, pops in to ask about “mindfulness” and CAM. In response, Bertolini basically repeats the same talking points that he has before, emphasizing his introduction of yoga and mindfulness, the preliminary data of his uncontrolled pilot study, and how he knows this stuff “works.” One thing that he inadvertently reveals is that he still has chronic pain from his neuropathy that sounds quite difficult to deal with, which he describes as “terrible pain down my left arm all day long.” This rather conflicts with what he says later in his account, namely that craniosacral therapy, acupuncture, and naturopathy have rendered him mostly “pain free” without drugs. He also points out that the program he put together for Aetna for its employees involving mindfulness and yoga was put together for the express purpose of “proving” that these modalities work. That’s the difference between a scientist and a non-scientist. Non-scientists try to prove what they already know, or prove their hypothesis. In contrast, scientists usually design their experiments to test their hypothesis by trying to falsify it and remain open to the possibility that their hypothesis will fail. Let’s just put it this way. Mark Bertolini might be a good businessman and corporate manager, but he is no scientist. He knew what result he wanted, and, make no mistake, that attitude could easily bias the “research.”

Right now, Aetna does not cover much in the way of alternative medicine. It does cover acupuncture for a few indications, biofeedback, chiropractic, and TENS, which for some reason it lumps under CAM, maybe because of how often acupuncturists try to pass TENS off as being “electroacupuncture.” One can’t help but wonder if that will change under Bertolini’s leadership. Certainly, he speaks as though he wants to try to see that it does.

Ironically, back in the 1990s Aetna was the insurance company that actually stood up for evidence-based medicine by taking a stand against Stanislaw Burzynski, a frequent topic of this blog because of his ineffective and dangerous “antineoplaston” therapy for cancer. It sued Burzynski. I know, I know. It really sued to recover payments for Burzynski’s treatments far more than it sued to stand up for science, but it’s odd to look at the contrast now. Aetna has a CEO who is thoroughly steeped in quackery and wants to promote it. If he wants to have Aetna pay for naturopathy, I would be surprised if, sooner or later, he doesn’t get his way.

Health insurance companies in the Netherlands put alternative medicine in an additional insurance and it is mostly limited to a certain amount of money. In a way it is a way to select higher educated and healthier people, who seem to be more interested in alternative medicine, while at the same time often have a healthier life-style.
Alas those additional insurances are not limited to alternative medicine, but they also cover physical therapy and some other science based medicine. I still do without, because I refuse to pay for bogus treatments. The Dutch society against quackery is very much against this package deal.

I utterly despise the way that health insurers provide cover for quackery. I assume some actuary or underwriter somewhere has decided it costs less to provide cover than it does in lost business, malpractice suits and all the rest.

I sometimes wonder what the law or the medical profession itself could do to force health insurers to provide actual health insurance instead of wishful thinking insurance.

Ack…of course the meeting was in one of the hives of woo–Tucson. FYI, I had a similar injury (to the brachial plexus) from playing football in high school. Thankfully I did not fully tear out the nerve roots but the pain was awful and it was not fun having an arm I could barely use. It took a months of physical therapy to rehab the arm, and I was told by the physical therapist how fortunate I was regain near-full function. I did not, however, require someone to rub my sacrum or perform acupuncture upon me. Imagine that–using a science-based approach and getting a good result.

The nurse must have been really overzealous over the volume of the blood sample.

This should hopefully start a new fad diet: participating to blood donation rallies. “Give your blood, and become thinner and healthier”.
If only… A bit of good may be done this way.
More likely, new “holistic” blood tests are likely to flourish.

Who would have thought the top man […] would be an advocate for craniosacral therapy and meditative chanting?

When I first read it, I thought the journalist was being hyperbolic and joking. I mean, an insurance broker going into meditative chanting? Well, that’s unfortunately no joke.

I assume some actuary or underwriter somewhere has decided it costs less to provide cover than it does in lost business, malpractice suits and all the rest.

This, especially the bit about lost business, is what it’s all about. Unfortunately, there are enough people with enough financial clout to demand this coverage, and the actuaries have figured out a way to make it at least break even, if not turn a profit. What this means is that in many cases the rest of us have to pay more for insurance because this coverage is bundled into our policies.

We know this stuff works. We believe in this, it’s just building the evidence base.

As Paul Simon put it: “Still a man hears what he wants to hear/And disregards the rest”.

You could view the cost of woo vs the cost of SBM this way–
1)There are, unfortunately some MDs who clearly aren’t using SBM guidelines for the tests and studies and referrals they do for their patients. Even those of us who do use SBM may sometimes still order CYA tests given the malpractice climate in the US. 2) All the big insurance companies can probably figure out about how much MDs treating outside of SBM guidelines is costing them. 3) Same insurance companies probably can look at woo and predict how much it would cost for acupuncture, sacral manipulation, reiki, etc for the same things the MDs are working up. 4) Somewhere they determined they can save money if they cover woo compared to SBM. 5) Always remember, insurance companies can’t be sued anyhow because that is the law.

Oh chronic pain, what fun. If ever we needed a woo-attractant to take over from when cancer isn’t blood-in-the-watery enough there it is.
First let me state that i am a chronic pain patient. I have a nicely rare joint disorder which leads to pain on a very long term, and which has no real treatment other than pain meds. Call that a COI if you will.
Unfortunately chronic pain is one of the areas where society forces medics into making the wrong decisions, and forces patients into a pit of agony and woo for no reason other than the ghost of William Randolph Hearst.
I speak mainly of the UK but some of this is cross pond. If you have a regular repeat prescription of opiates ( I do, they are just fabulous baby) then you are treated to a variety of interventions all of which are designed to get you to stop using pain meds.
Now this may sound laudatory but such a blanket approach ends up with horrible gaps in it, guaranteeing that you get patients in horrible pain who are refused pain medication- and thats where the woomeisters appear.
Its an old saw that nociception=/=pain and so woo such as mindfulness etc. can indeed help to a degree. but all it is is another word for taking your mind off it. And with the constant blame-the-victim background which says if its not working you aren’t trying and are just an evil junky it ends up as a horrible horrible mess.

RE:In any discussion of medicine, referring to “allopathic doctors/physicians” automatically loses you the argument.
Good? Bad? Suggest an alternative?
When my husband and I got our shots for a trip to the Galapagos (best trip ever!), the doc referred to himself as an allopathic doctor. And I remember telling him I didn’t want him to use that adjective-he was a doctor-period.
I’ve heard “conventional medicine.”A student suggested “alternative practices.” Of course, practice won’t make perfect, but hey, what does?

Agreed.
“It’s your own fault that you’re suffering and you should follow the example of those who can deal with pain because they are obviously of superior moral fibre”.

So much of alt med revolves upon this axis:
they can fix themselves by will power or correct choices(tm) and don’t need the evil meds that weaklings do. Which makes you entirely unworthy and dismissed.

I’ll venture that this is their OWN denial of reality- in which they believe that their will can stave off negative events- unfortunately, their own quasi-religious system of judgment affects others.

@Denice
indeed. in the UK at the moment many pain management clinics ( which ought to be good resources) have swallowed the Kool Aid of mindfullness. There is also a firm belief that addiction must be a bad thing, that pain meds are also a bad thing in and of themselves and that opiates and opioids are the most dangerous of the lot. Significant numbers of operatives from these establishments believe that opiate induced hyperalgesia affects ALL opiate users.
Essentially its good old fashioned puritanism. And very poorly supported in evidence.
Chronic incurable pain is one of the last great areas where the patients needs and quality of life comes in a poor second to ideology. And it is very difficult for anyone who has not experienced it for themselves to understand it.
Ones own relatives will often try to hide the pills, saying how it changes you. But as Maria, a great friend of mine from elsewhere on teh web, says you can have me being stoned and 70% me or in agony and 5% me.

sorry to bore those who came for the popcorn. TL:DR…chronic pain management is awful.

A check of Mr. Bertolini’s background shows he has an undergraduate degree in business administration and an MBA. Neither of these qualify him as a statistician or a medical expert in even the most rudimentary sense, so it’s unremarkable that he’s a believer in woo. His science knowledge and understanding of probability is likely no better than the average public high school graduate in the US. He’s just trying to sell insurance and make a profit for investors (and himself.) Meh. Sad, but…meh.

Harold…I have an MBA. We were required to take two semesters of statistics and modeling, so Mr Bertolini has no excuse. If he runs a business based on “what he knows” rather than what the market is telling him, Crom help Aetna.

There is also a firm belief that addiction must be a bad thing, that pain meds are also a bad thing in and of themselves and that opiates and opioids are the most dangerous of the lot.

And yet I seem to recall seeing an article in Scientific American back in the 1980s which described tests showing that morphine is not addictive at all if used correctly for pain relief; that the addicting aspects only came into play if it was used for more than that.

@ incitatus
I too suffered from chronic pain (past tense because of a genius GI doc who just didn’t give up.) But for those 5 yrs, when the pain got to be too much, I dreaded heading for the ER, just because I could just about HEAR them whispering “she’s back!” I have to admit, even at the pain clinic, I never got any mindfulness baloney, and my GI docs were wonderful, but everybody else…..
You have my complete understanding and empathy. (And opiates are awesome!)

A check of Mr. Bertolini’s background shows he has an undergraduate degree in business administration and an MBA. Neither of these qualify him as a statistician or a medical expert in even the most rudimentary sense, so it’s unremarkable that he’s a believer in woo.

My Ph.D. is in physics, so I am not any more qualified as a medical expert than Bertolini is. What I do have, and which Bertolini should also have but doesn’t, is a functioning BS detector. As Shay says above, Bertolini should know a thing or two about statistics. Furthermore, considering that he is paid to maximize the profit of an insurance company, he should be in favor of minimizing unnecessary payouts (unless he can raise enough revenue to compensate for it). And even a high school graduate should know that certain forms of woo, e.g., homeopathy, have no basis in reality: they do teach Avogadro’s number in high school chemistry classes, don’t they?

If the number of visits per year are capped, acupuncture would be very profitable. My friend pays for a rider on her HMO that covers it. She’s totally math challenged so she’s never bothered to calculate that she pays more in premiums than she’d pay by finding her own acupuncturist. Especially because she only gets acupuncture if she has some health issue, so she doesn’t use her full allotment.

One of my complaints is that government employee health plans pay for acupuncture and chiropractic. Or, at least 10 of 16 do–I got bored with reading plan benefit brochures and quit before I got to the end.
If I had any idea who to contact about what is and is not covered in those plans, I’d do it today.
(they don’t cover acupuncture for everything, but they do for some pain problems and nausea from chemotherapy)

Wait, what? The guy runs a business which is parasitic upon the health system — it works as a middleman for the process of paying for health-care delivery. And he therefore feels qualified to call for the destruction of that system? Much like a car-insurance dealer calling for the “creative destruction” of transport infrastructure?

It must be reassuring for Aetna customers to learn that the guy they’re paying wants to destroy the system that they’re paying for. Also reassuring for Aetna shareholders to learn that their best-paid employee has no sense of discretion.

@HDB: There are aspects of the US health care system which could benefit from a bit of “creative destruction”. Such as the way that Bertolini gets paid for running a health insurance company, as you correctly note. Of course, those aren’t the aspects Bertolini meant by his comment. As always, it is difficult to get a man to understand something when his paycheck depends on his not understanding it.

So exactly why is Bertolini not being shown the door? He’s being paid some fantastically large amount of money (I’m not sure I want to know exactly how much) for his alleged business acumen, which appears to be just enough to run his company into the ground. I could run the company into the ground as effectively for much less.

The lymphoma that Mr. Bertolini’s son apparently had is classified by the WHO as Hepatosplenic T-cell lymphoma. It is very rare (<1% of all non-Hodgkin lymphomas), I have never seen a case. It has a median survival of less than 2 years.
If his son is the "first person" to survive this disease, Mr. Bertolini seems very ungrateful to the doctors who are responsible. Does he feel that death is preferable than living with a stroke and a kidney transplant?

HDB,
Thanks, I hadn’t previously realized that about postural yoga. It seems it was mostly invented in 19th century Scandinavia, made its way to India along with some wrestling exercises and was introduced to Europe and America repackaged as ancient Oriental wisdom. For some reason I find this very amusing.

I wonder how Bertolini’s son would have survived without good health care insurance to pay for the state-of-the-art cancer care, bone marrow transplant and kidney transplant.

He has an “interesting” background; his undergrad degree is from Wayne State University, he trained as a paramedic and his own skiing accident, plus the extraordinary medical care his son received, make him well suited to evaluate CAM treatments….or so he says.

@incitatus – I too am a chronic pain patient in the US. There are regular horror stories shared by others who have my illness about being dropped by doctors when rules change in their state, or when the doctor retires, etc., and being unable to get any further treatment and being left sometimes for a hard, untapered withdrawal.

I struggle most with being what I really believed was a former “tough cookie” – I even walked with a broken leg (not terribly broken, obviously, but nonetheless) because I knew there was surgery scheduled for the ankle in two weeks – figured they could fix it when they got in there (the surgeon was a little perplexed when she got in there). I didn’t ask for pain medication until the pain had my body so worn down it made me sick. For some reason, though, with all the attitude around regular narcotic use, it is a really hard thing. And you’re right – when woo gets into it (or even faith healing – I’ve been accused of being possessed when I wasn’t immediately better!) it becomes a serious “blaming the victim” when we are, for whatever reason, not as suggestible as some and don’t fall into the placebo affect category.

“Furthermore, considering that he is paid to maximize the profit of an insurance company, he should be in favor of minimizing unnecessary payouts (unless he can raise enough revenue to compensate for it).”
If I understand correctly, under the ACA, insurance companies are guaranteed 15-20% of every premium dollar. If costs increase for whatever reason, and spending on useless CAM would do it, Aetna would simply raise the premium. Then they will have 15-20% of a bigger pie. If all the insurance companies do this, it would be the next bubble.

Well, there are 31 (I’m not sure what No. 32 refers to) in the 17th-century Gheranda Samhita (PDF, p. 12), not all of them seated and most still common, so the strongest version of the claim doesn’t hold.

Another beautiful idea maimed by cruel facts. I think it’s the moving yoga that is taught in evening classes all over the western world that may lack an authentic Hindu heritage. There are a finite number of postures a human body can be contorted into, I suppose.

I seem to remember Aleister Crowley claimed that asana was developed as a firm physical posture suitable for long periods of meditation that might include spontaneous levitation, and others that it is supposed to increase longevity enough for enlightenment to be attained in one lifetime. Both these notions seem somewhat removed from all those middle-class white people stretching in the local community center.

I think it’s largely true; this is the earliest place I found standing asanas (but I only skimmed those in the Hatha Yoga Pradipika). Having sifted this guy for as long as I could stand, he’s pretty clearly bluffing – he simply points over and over at textual examples of sitting postures and hand-waves his way to tadasana and vrikshasana as being some sort of core yoga exemplars.

Is psychology quackery?
Apparently, according to umpteen randomised controlled trials — yes, it is. I console myself with the thought that my speciality is academic rather than clinical.
*Psychiatry* is a different field, with different treatment options.

@weing in comment 46,
The ACA does not guarantee profits, it *limits* insurance company profits to 15-20%, and has penalties & requires refunds if they go higher. Insurance companies were used to skimming off even more.

Here in Australia we can also opt to have private health insurance in addition to Medicare. This gives access to dental & optical insurance, and the option of a private hospital with your own nominated specialist (in the public system you get the ‘Doctor du Jour’ of whichever specialty team you are admitted under) to name but a few things.
What REALLY irritates me is that there is not one private health insurance company in Australia that does not include sCAM in their ‘extras’ package – the one where physio, prostheses, some medications, lifestyle stuff (excercise, weightloss) sit, and what I need. I will never use chiro, naturopathy, homeopathy, acupuncture, which seem to be across the board inclusions, with some companies having other sCAm modalities as well, like TCM etc.
As far as I’m concerned the sCAMs should have their own, separate opt-in package, because I really hate paying for insurance for something I will never, ever use :/

And to all those commenters here re chronic pain management, who are living/have lived with chronic pain – I share your experiences and concerns.
I’ve had two major lower back injuries a couple of years apart (several years ago now), and the ol’ degenerative age changes are now kicking in too. Opioids were the bestus but I was wayyy too sleepy! Regular high dose panadol is working a treat, with anti inflammatories, anti spasmodics and tramadol when required. It took a long time to get here, I still have bad days, but I have a great doc and physiotherapist.
Although tramadol has recently been taken off the pharaceutical benefits scheme here, so now I have to pay a small fortune for it :/
But yes, when it’s really bad you dread going to the ED, and the depression that I developed wasn’t funny either. I stayed away from the local pain clinic because they too are into this ‘mindfulness’ BS. When people are in pain, treat the damn pain!

The basis would be that it’s ‘costing too much’. I too scratch my head at bean-counter decisions.

Of course, that only affects people like me who do not have a govt benefits card (welfare for my US friends here) or an aged care pension. For those people it will cost them a capped amount of under $10.
For peeps like me who are deemed able to pay, we pay.